Monthly Archives: December 2015

To all those in the workers’ comp world who have pooh-poohed the idea of less expensive surgeries outside of the US, I give you the following blog post from Archimedicx for you to ponder while you are celebrating the birth of a Jewish carpenter.

Out of the ten hospitals mentioned, there is one US hospital. So that tells you that you are wrong, and that international hospitals are less expensive and can provide equal or better care than what is available in the US.

So those of you who think my idea is ridiculous and a non-starter, and you know who you are, look in the mirror. You are the ones with a ridiculous and stupid idea.

Merry Christmas, and a Happy New Year! Maybe 2016 will be the year workers’ comp grows out of its narrow-minded, American exceptionalism and embraces the globalization of health care.

Willing to work hard, willing to learn, willing to teach, salary commensurate with experience, both professional experience and life experience.

Successful blogger with excellent written and verbal skills, strong financial and organizational skills, as well as strong analytical and problem solving skills, .and can think outside the box.

Has strong knowledge of economic, social and political issues, as well as strong interest in global issues, including the growth and development of medical tourism.

Location is flexible, provided it is amendable, would consider non-US positions provided relocation is included. Strong English language proficiency, willing to learn others as well.

Will consider consulting opportunities. Contact me by email at: richard_krasner@hotmail.com or by phone, +1-561-738-0458, or cell, +1-561-603-1685. Resume/CV will be provided upon request, or can be viewed on blog or LinkedIn profile.

Then in March of this year, ProPublica’s Michael Grabell and NPR’s Howard Berkes, wrote an article called, “The Demolition of Workers’ Compensation“, which was a first in of a series about the workers’ compensation system.

In the article, Grabell said that in 37 states, the worker cannot choose his doctor, or they are restricted to a list provided by their employer. This statement generated some concern from the industry.

My fellow blogger, Joe Paduda tried to get them to see both sides, but gave up the effort when it did not result in any discussion between them, as he wrote about the following day, calling the reporting a “public disservice”.

The next day, I wrote to Mr. Grabell, and told him that his facts were wrong. He told me in his response that he relied on data from the US Chamber of Commerce.

I told him that the WCRI and the state statutes were a more accurate source of information. My email thread covered eight messages that day. I provided him with the data I used in the articles cited above, and in the presentation I gave the previous November in Mexico.

Lower Costs When Doctor is Chosen By Employer

Business Insurance’s Stephanie Goldberg today reported on a study published in the latest issue of the Journal of Occupational and Environmental Medicine, that found that the average medical cost per work comp claim is lower in states where the employer chooses the worker’s initial treating physician.

Average medical costs were $308 lower in those states where the employer can choose the treating doctor for employees with low back pain, than in states where the workers were allowed to choose, Goldberg reported.

The study, sponsored by the Liberty Mutual Research Institute for Safety, said that states limiting treating provider change had higher medical costs than states that allow a one-time change.

There was however, the study found, no significant difference in average medical costs between cases in states that limit initial change and states that don’t, according to Goldberg.

Employers participating in a managed care organization, preferred provider organization or coordinated care organization in states like California and Florida, are allowed to to direct care. States like Arizona and Massachusetts allow workers to chose their providers.

The study also found, that the average medical costs ranges from $1211 in New York to $4514 in Texas, and length of disability ranged from 19 days in Missouri to 69 days in Texas.

The study was compiled using more that 59,000 low back pain claims between 2002 and 2009 from 49 jurisdictions, including Washington, DC, and did not include North Dakota and Wyoming.

According to Joe, the efforts by the states are just that, state-based, and they are allowed and enabled by federal legislation…separate and distinct from the ACA.

Joe cites an article written by Michael Stack, Principal of Amaxx LLC that summarizes Medicaid recovery in workers’ comp cases.

As Joe reports, Michael noted that the legislation that allows Medicaid to pursue settlements was part of the Medicare Secondary Payer Act, a part of the 2013 budget bill.

Normally, when I write about some issue someone else wrote about, I never have to provide my readers with an update that challenges the original author. Generally, my updates are just that, updates that add to the discussion. This is not the case here.

So just to be fair to everyone, I decided to correct the situation by writing a follow-up. I trust my readers will understand that I did not mean to mislead or take only one side.

MaryRose Reaston, founder of Emerge Diagnostics, wrote an article on Insurance Thought Leadership.com today that said the Affordable Care Act (ACA), also known as “Obamacare” will dip into Workers’ Comp.

According to MaryRose, as of Oct. 1, 2016, state Medicaid programs will be able to recover all of the proceeds from a settlement that were expended on behalf of a beneficiary.

Medicaid, she says, will be able to attach a beneficiary’s third-party liability settlement (including workers’ compensation) for the entire amount of the beneficiary’s award, and not just the amount allocated to medical expenses.

What this means, Reaston adds, is that funds intended to compensate beneficiaries for pain and suffering, lost wages or any damages other than medical expenses could be subject to the reach of state Medicaid agencies seeking recovery.

Many employers will be affected because the adoption of the ACA has afforded broader coverage under state Medicaid programs, MaryRose writes, because it now includes individuals who are within 133% of the federal poverty level (about $32,252.50 for a family of four in 2015), and under 65 years of age.

Quotes

“Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”

– Muhammad Ali

“If people are not laughing at your goals, your goals are too small..”

– Azim Premji

“Those who say your dreams are ridiculous have given up on theirs.”

– Unknown

Permanence, perseverance and persistence in spite of all obstacles, discouragements, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak.

– Thomas Carlyle

“As the work is done for the employer, and therefore ultimately for the public, it is a bitter injustice that it should be the wage-worker himself and his wife and children who bear the whole penalty.”

– President Theodore Roosevelt, 1907

To permit every lawless capitalist, every law-defying corporation, to take any action, no matter how iniquitous, in the effort to secure an improper profit and to build up privilege, would be ruinous to the Republic and would mark the abandonment of the effort to secure in the industrial world the spirit of democratic fair dealing.

– Theodore Roosevelt, 1908

“The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”

– John Kenneth Galbraith

“Only a fool would try to deprive working men and women of their right to join the union of their choice.”

– Dwight D. Eisenhower

“I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.”

– Thomas Jefferson

“Mischief springs from the power which the moneyed interest derives from a paper currency which they are able to control, from the multitude of corporations with exclusive privileges… which are employed altogether for their benefit.”

– Andrew Jackson

“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. Corporations have been enthroned, an era of corruption in high places will follow, and the money-power of the country will endeavor to prolong it’s reign by working upon the prejudices of the people until the wealth is aggregated in a few hands and the Republic is destroyed.”

– Abraham Lincoln

“Do not go where the path may lead; go instead where there is no path and leave a trail”

– Ralph Waldo Emerson

“Some men see things as they are and say why. I dream things that never were and say why not.”

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

– Karl Marx

“The secret of change is to focus all of your energy, NOT on fighting the old, but on BUILDING the NEW.”

– Socrates

“Every man takes the limits of his field of vision for the limits of the world”

– Arthur Schopenhauer

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

– Arthur Schopenhauer

“You have enemies? Good. That means you’ve stood up for something, sometime in your life.”

– Winston Churchill

“No matter what people tell you, words and ideas can change the world.”

– Robin Williams

“There can be no equality or opportunity if men and women and children be not shielded in their lives from the consequences of great industrial and social processes which they cannot alter, control, or singly cope with.”

– Woodrow Wilson

“Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservative.”

– John Stuart Mill

“The masters of the government of the United States are the combined capitalists and manufacturers of the United States.”

– Woodrow Wilson

“The test of our progress is not whether we add more to the abundance of those who have much it is whether we provide enough for those who have little.”

– Franklin D. Roosevelt

“Of all the forms of inequality, injustice in health [care] is the most shocking and inhuman[e]…”